What I'm telling the GP

Before I begin treatment, I write a letter to the dentist (GP, general practitioner) to explain what I'm going to do. The letter I wrote today was exemplary enough (as in: a perfect example), that I thought I might share it with you.   You may use it yourself....(p.s.: I'm using a fictitious name....)...

"Dear George,  Hi. It's Barry Raphael, orthodontist for Stephanie.   Below is a summary of my treatment plan for Stephanie and attached are copies of records.  Please review and consult with Stephanie's father and mother with your opinion.

First some background.  Before I move teeth, I like to look at the cause of the problem.  Orthodontics has long been plagued by trying to treat and maintain teeth when the etiology has not been rectified.  I particularly look at muscular habits,  especially during breathing, swallowing and sleeping.  Mouthbreathing and tongues not positioned on the palate are, I feel, responsible for many of the malocclusions we see, Stephanie included.  

Her narrow palate, posterior crossbite and anterior openbite are typical of such issues.  As such, my preliminary treatment is aimed at eliminating the harmful habits.  Once reduced, straightening the teeth become much simpler.  More importantly, however, these habits and the poor growth patterns that ensue are associated with the sleep disorders that adults are now often struggling with.  No matter the orthodontic protocol I choose, she will be predisposed to sleep disorders if the habits are not corrected.

Correcting harmful habits, unfortunately, is like giving dance lessons - many will participate but only those that are motivated and work at it will succeed, and even then to varying degrees.  Without Stephanie's and her parent's understanding and participation, the results will diminish, and she will be likely be subject to typical orthodontic regimines like extractions and retractive mechanics - something I try to avoid whenever possible.

Stephanie's treatment will begin with a removable (by her choice) expander to widen the palate and establish room for the tongue.  Then myofunctional training to 1) keep the lips closed, 2) keep the tongue on the palate, and 3) breath through the nose, especially at night, will begin.  Again, her cooperation with these exercises is paramount to success.

Should she have difficulty with the exercises I proscribe, a referral to an Oral Myologist will be made for a more specific and individualized therapy.

Finally, when she is on the way out of the mixed dentition (estimated age 11-12), I will re-evaluate for fixed appliance therapy.  If the myofunctional work is effective, only alignment will be needed.  If it is not, then more complex treatment will have to be considered.

If you are not familiar with the above approach, or would like to learn more about it out of curiosity, I will be happy to forward some links to more information. You can start here.

Sincerely,  Dr. Barry Raphael "